Maine lawmakers to consider single-payer health care system

Supporters of the bill want to adopt a government-run program, but a critic calls that unwise and expensive

By Joe LawlorKennebec (Maine) Journal, Jan. 21, 2014

Jim Miller, president of WoodenBoat Publications in Brooklin, wants the decisions about how to provide health insurance for his employees taken out of his hands.

“I hate playing God,” he said. “Every spring I am forced into that position.”

Spring is when his company’s health insurance policies come up for renewal and he has to balance rising costs against being fair to his 30 employees.

Miller supports a legislative proposal for Maine to adopt a system that would replace employer-sponsored health insurance with a government-run program.

Starting in 2017, states can adopt such single-payer systems under the Affordable Care Act, using federal funding that now goes to states for programs such as the health insurance marketplace.

Maine’s bill will be discussed by a legislative committee Thursday in Augusta.

“The ACA is the first step toward a single-payer system,” said Rep. Charles Priest, D-Brunswick, the bill’s sponsor.

Priest concedes that it will be hard to get the bill passed this year, with opposition from Republican Gov. Paul LePage.

“Obviously, it’s a new concept for Maine,” Priest said. “I look at now as a time to educate people about single-payer.”

While there are many ways to create a single-payer system, a simple analogy is that Medicare would be expanded to everyone. Other countries, including Canada and the United Kingdom, operate single-payer health care systems.

Priest said details for the funding and operation of Maine’s single-payer system would be worked out later, if the bill became law. Vermont has already approved a single-payer system, but has not yet decided how to implement it.

Miller, at WoodenBoat Publications, said he would rather spend time on his core business – which includes publishing magazines, operating a mail order business and running a sailing school – than on health insurance paperwork. He was one of about 50 people who testified in favor of the bill before the Legislature’s Insurance and Financial Services Committee on Jan. 9.

But Rep. Joyce Fitzpatrick, R-Houlton, a member of the committee, said she doesn’t believe it’s a good idea. She said she doubts the system would save money, despite advocates’ claims that a streamlined system that de-emphasizes insurance companies would be more cost-efficient.

“We all know how much things cost when the government gets involved,” Fitzpatrick said.

Considering all of the work being done to get the Affordable Care Act working properly, she said, it would be unwise for Maine to switch gears and install a massive new system.

“I think there’s too much going on in health care to try to do something different,” Fitzpatrick said. “The ACA is the law of the land, so why would we try to re-create the wheel?”

In a single-payer system, insurance companies would be eliminated or greatly reduced. The Maine Medical Association, an advocacy group for physicians, has reservations about that.

“We support universal access to health care coverage,” said Gordon Smith, the association’s executive vice president. “We’re not prepared to throw the commercial insurance carriers, at this point, out the door.”

Representatives of the insurance industry testified against Priest’s bill, arguing that single-payer systems limit competition, and choice for consumers.

Smith noted that doctors are reimbursed at higher rates for patients with private insurance, making up for lower reimbursements for patients on Medicare or Medicaid. A new system would have to smooth out the discrepancies and ensure that doctors are paid fairly for their services, he said.

But Joe Lendvai of Maine AllCare, an advocacy group that supports a single-payer system, said he believes that businesses would flock to states with single-payer systems because they would no longer have to carry insurance for their workers.

“Imagine if small businesses, or any business, could be entirely focused on the products and services they provide, and not worrying about insurance,” he said.

Maine AllCare is poised to gather signatures to put the issue on the statewide ballot by 2017, if the Legislature doesn’t act by then.

A written statement from the governor’s office details why LePage believes single-payer is not the answer.

“A single-payer health care system will not fix the problem,” said Holly Lusk, senior policy adviser for LePage. “Making care free to people means they will use more of it. Using more care will accelerate cost growth even more.”

LePage’s opponents in this year’s race for governor, Democratic U.S. Rep. Mike Michaud and independent Eliot Cutler, were noncommittal in statements issued to the Portland Press Herald.

Michaud wrote, “I would be interested in exploring a single-payer system down the road, but right now the most important thing we can do is fully implement the Affordable Care Act by expanding access to health care to 70,000 eligible Mainers (by expanding Medicaid) and creating a state-run exchange.”

Cutler wrote that the “important issue is less who pays than what we pay for.”

“Truly universal access to preventive care is the key. We will decide with the Legislature whether the structure ought to be single- or multi-payer,” Cutler wrote. “We must focus on keeping people healthy, so that we are not just paying for costly procedures after people get sick.”